Alzheimer's Disease (AD) is more prevalent than any other disease under the umbrella of dementia (Alzheimer's Association, 2013). Certified Nursing Assistants (CNAs) are the typical front-line care staff who care for individuals in aging care (Sengupta, Harris-Kojetin, & Ejaz, 2010). The present study investigated the use of a pyramidal training model to teach aging facility staff to be able to conduct trainings and to teach direct care staff antecedent strategies shown to be effective when communicating with individuals with AD. Pyramidal training resulted in two tiers of staff successfully implementing training for subsequent tiers of staff and subsequent staff demonstrated mastery of the trained material. However, during maintenance observations, some decreases were observed both with regard to training integrity as well as implementation of the trained material.

Parents of children with an autism spectrum disorder experience many stressors in their lives, including managing problem behaviors of their child. Parent training can effectively teach parents strategies to manage noncompliant behaviors; however, many parents spend months on wait lists before accessing this service. This study investigated the preliminary effects of both an expert-led and parent-led training for wait-listed parents. Thirteen parents of children currently on a waitlist to receive behavioral analytic services participated; most were highly educated, all were white and married. The study used a pyramidal training approach: a professional instructed one group of participants while a participant volunteer instructed the second group. Participants completed a training on several behavior management techniques. Training was conducted in a manner plausible for community clinics to implement. Checklists and direct observations of trainee behavior were taken to observe fidelity of training. Data were also collected using parent self-report measures using Likert-scales to report on their own behavior as well as their child’s behavior. Participants from both groups reported decreases in child noncompliant behavior and increases in parent self-efficacy, confidence and consistency in administering behavior management techniques, indicating that both expert-led and parent-led training are effective in decreasing reported noncompliant behavior and increasing parent-reported self-efficacy. Clinics and communities should seek to implement similar programs to address wait-list issues; using a pyramidal parent training module may allow more parents to access information in a more efficient fashion. Further research should be conducted on larger groups and additional levels of pyramidal training.

Families of children with autism spectrum disorder (ASD) in developing countries may not have as much access to needed behavioral services as families living in developed countries. Caregivers of children with ASD in developing countries would benefit from an affordable, efficient parent training to teach them behavior techniques to use with their children. Pyramidal training is a cost-efficient method of training individuals through peers and would be a supportive intervention for families in developing countries. This study used a repeated acquisition design across three variables to examine whether a caregiver could train another caregiver on three behavioral interventions. These interventions were appropriately redirecting repetitive behaviors, using praise, and requesting eye contact. The study also examined if the caregivers could acquire the three skills and the extent caregivers were receptive to this training model based on their comments about the training. The participants were six ethnic Macedonians or Albanians between the ages of 38 and 43 who were caregivers of a child with ASD. The results indicate the caregivers were able to train another caregiver on three skills for working with their child with autism, all the caregivers were able to acquire the three skills, and the training model's goals were socially appropriate based on participants' comments. This implicates professionals such as doctors, social workers, behavioral therapists, or school psychologists could use this form of parent training to share information throughout a family in order to benefit children with disabilities and their families.

Training and empirically evaluating caregivers’ implementation of behavior management skills is a particularly challenging task in large residential contexts. A pyramidal training approach provides an efficient and effective way to conduct large-scale competency-based behavior skills training. The purpose of this project was to develop and evaluate a large-scale pyramidal staff training program for behavior management skills. One hundred nine caregivers and 11 behavior service professionals at a large, residential care facility participated in this project. Interobserver agreement was utilized to develop and refine measurements systems to detect caregiver acquisition of skills, behavior service professionals’ ability to score caregiver performance and behavior service professionals’ ability to deliver a specified portion of the curriculum. Pre- and post-test probes were conducted utilizing standard role play scenarios and checklists to evaluate caregiver acquisition of three specific behavior management skills. The results supported the following conclusions: first, interobserver agreement measures were useful to develop a reliable measurement system, to refine some curriculum elements, and to evaluate measurement conducted by behavior service professionals. Second, behavior skills training (BST) resulted in caregiver acquisition of all three behavior management techniques. Third, the pyramidal training approach was effective to teach behavior service professionals to deliver BST and accurately measure the performances of trainees.